Ensuring the effectiveness and safety of peripheral blockades

Adequate analgesia determines the success of the performed surgical intervention. In modern surgery, most of postoperative complications are directly related to ineffective therapy of pain syndrome in the perioperative period. The main principle of modern analgesia is its multicomponence, when analgesia, neurovegetative blockade and relaxation are achieved and potentiated by different drugs and methods. The blockade of nociceptive impulses with a local anesthetic at the transmission stage provides effective, targeted analgesia, hyporefl exia and muscle relaxation, prevents the sensitization of neuroaxial structures, hyperalgesia and the development of postoperative chronic pain syndrome. At the same time, providing analgesia with drugs of central action leads to the ineffectiveness of therapy in 80 % of cases, which has serious consequences.The aim. According to the literature review, to evaluate the effectiveness and safety of peripheral blockades on the example of performing a blockade of the pterygopalatine ganglion.Conclusion. The pterygopalatine blockade has broad indications for use in ophthalmology, which is explained by the complex structure of the pterygopalatine ganglion and the possibility of simultaneous infl uence on sympathetic, parasympathetic and nociceptive innervation. All the presented methods of pterygopalatine blockade performance have their advantages and disadvantages. Ultrasound navigation eliminates technical difficulties and the possibility of damage of the pterygopalatine fossa anatomical structures, ensuring the effectiveness and safety of the pterygopalatine blockade

МОДЕЛИРОВАНИЕ И РАСЧЕТ ПАРАМЕТРОВ УСИЛИТЕЛЯ ПОТОКА РУЛЕВОГО УПРАВЛЕНИЯ АВТОМОБИЛЯ ОСОБО БОЛЬШОЙ ГРУЗОПОДЪЕМНОСТИ

The paper analyzes prospects pertaining to development of methods for dynamic calculation of monitoring hydraulic units with various types of relations.  Calculated diagram of steering hydraulic drive with flow amplifier and turning cylinder has been given in the paper and its dynamic model has been developed. A hydraulic drive is considered as a system with lumped parameters. It is supposed that properties of working fluid are unchangeable during transient process; leakages and cavitations do not occur; fluid can be pressed; resistance of service drain line is taken into account. Model has been developed with due account of resistance of manifolds and internal channels of flow amplifier, hydrodynamic forces, that influence on amplifier control valves, and friction forces of movable elements. Multi-variant dynamic calculation has been done and some results of the investigations are presented in the paper. The paper also contains analysis that shows influence of various design and component parameters of flow amplifier on the drive dynamics. Анализируется перспективность разработки методов динамического расчета следящих гидроагрегатов с различными типами связей. Приведена расчетная схема гидропривода рулевого управления с усилителем потока и цилиндром поворота, разработана его динамическая модель. Гидропривод рассматривается как система с сосредоточенными параметрами. Предполагается, что свойства рабочей жидкости не изменяются во время переходного процесса, утечки и кавитация отсутствуют, жидкость сжимаема, учитывается сопротивление сливной магистрали. Модель составлена с учетом сопротивления трубопроводов и внутренних каналов усилителя потока, гидродинамических сил, действующих на золотники последнего, и сил трения подвижных элементов. Проведен многовариантный динамический расчет, представлены некоторые результаты исследований, выполнен анализ влияния различных конструктивных и компоновочных параметров усилителя потока на динамику привода

Pulsed radiofrequency ablation for treatment of severe pain after shoulder arthroplasty (case report)

A case of refractory neuropathic pain syndrome in patient who underwent monopolar shoulder replacement is presented. The patient had right lung tumor metastasis in the right humeral head. Severe neuropathic pain syndrome, not responding to 6-months conservative treatment, developed in post-operative period. Pulsed radiofrequency ablation of C4-C6 nerve roots via interscalene access was performed. The procedure allowed the patient to stop taking painkillers and improved his quality of life. The patient was monitored for 2 months

ANESTHESIA FOR MICROSURGICAL AUTOTRANSPLANTATION OF TOES ON THE WRIST IN CHILDREN WITH CONGENITAL AND POSTTRAUMATIC PATHOLOGY

Intraoperative combination of monolateral spinal anesthesia and prolonged brachial plexus block is evaluated in 65 children with autotransplantation of fingers from foot to hand. Variability of heart rhythm demonstrated autonomous stability in the main group. Dynamical study of skin temperature and dopplerographic evaluation demonstrated local sympatholysis in the blocked extremity. Significant improvement of circulation and quality of analgesia is revealed in case of prolonged perineural use of local anesthetics in the postoperative period. Described combination of intra- and postoperative treatment of such patients makes complex treatment more effective

ARTHROSCOPY POSSIBILITIES IN TREATMENT OF INJURIES OF THE SHOULDER ROTATOR CUFF

The authors analyzed the results of arthroscopic treatment 58 patients with various injuries of rotator cuff. Follow-up was from 4 months to 3 years (average 18 ± 5,2 months) after surgery. The quantitative MRI characteristics allowing to define prognostically unfavorable variants of rotator cuff surgery are presented. The authors considered the ways out of such situations including the partial restoration of the rotator cuff structures by arthroscopic method and reverse shoulder arthroplasty